A consultation on the provision of specialist residential chronic pain services in Scotland

Chapter 2: Options

How were the service options developed?

On behalf of Scottish Government and NHS Boards a group was convened to consider the provision of intensive pain management service(s) in Scotland. Membership included patients with chronic pain, third sector organisations and chronic pain clinicians. The group was asked to develop options which are broadly presented in this consultation paper.

The Scottish Government is keen to hear from people who may have other ideas that are not presented in the options. Questions have been included in the respondent form inviting further suggestions. Factors are also set out after the options that may help you identify a preferred option.

There are some factors that are important and common to all the residential options set out. These are:

• The service would be accessible to patients in Scotland, regardless of NHS Board area, who are clinically assessed as likely to benefit. This could include remote ways of working, particularly for those living in remote and rural areas.

• Patient choice is important, therefore if individuals live near to the new service they could, if they wished, go home at night or stay with family or friends nearby. However, one of the aims of providing a service in Scotland is to reduce travelling long distances. Staying in the same place as fellow patients has been shown to be supportive and may lead to continued informal support after treatment. Therefore the offer of residential accommodation will be open to all.

• The majority of patients will still need to travel, but this will be within Scotland.

• Local chronic pain services provided by NHS Boards need to be able to support patients following the treatment provided in the residential service. This is to ensure on-going support and continued improvement.

• The service would need to demonstrate improved outcomes for patients, and monitor their experience and the views of staff.

Option 1

A centre of excellence in a single location.

This option would see a national treatment and residential service developed in a single location, with a range of staff specialising in chronic pain. Local residential accommodation would be offered to those patients who wish to stay.

Service comparison - this type of residential service is similar to those provided in;

Bath Centre for Pain Services, Bath, Somerset,

http://www.bathcentreforpainservices.nhs.uk/

Pain and Fatigue Management Centre at Bronllys, Wales,

http://www.wales.nhs.uk/sites3/home.cfm?orgid=470&redirect=yes

INPUT pain management unit, Guys and St. Thomas's, London, http://www.guysandstthomas.nhs.uk/our-services/pain/input/overview.aspx

It is therefore a tested service model where improved patient experiences and clinical outcomes have been demonstrated.

Option 2

A service delivered by local chronic pain clinicians supported by other clinical advisors in another part of the country.

This option would see local skilled chronic pain teams providing the service with remote support provided by other experienced staff from, for example, a central point or hub. Remote ways of working could involve tele-health, phone and video links or other technology.

An example of what this means for a patient is they could have a consultation and assessment in their local area with their own clinician(s) but also involve other clinical advisors using technology (i.e. tele-health or videoconferencing) but the clinical advisor would be in another part of the country.

The clinical advisor would then work with and support the local team. The actual treatment on a day to day basis over a 2 - 4 week period would be provided by the local team. Local residential accommodation would be offered to patients who wish to stay. This could apply throughout Scotland.

This sort of service would be supported by staff who would collect information about the service, including patient experience and clinical outcomes.

Similar service models are used for other chronic health conditions which need a very specialised service and access to additional advice. These have shown improvements in patient experience and clinical outcomes and therefore this is a tested model.

Option 3

A service delivered in different locations by a team of chronic pain specialists (an outreach or roving service).

This service would be provided by a specialist chronic pain team who would go to different parts of the country.

The team would be organised and managed by one NHS Board but travel to other health board areas to carry out assessment clinics. They would then work with and support local teams to deliver the treatment daily over a 2 - 4 week period.

Local residential accommodation would be offered to those patients who wish to stay.

Service comparison - this model is not yet tested in the NHS in Scotland. So, at this consultation stage it is not known if it is viable. It is likely that for this option it would be difficult to recruit and retain staff as they would need to be away from home for 2 - 4 weeks to deliver the service. Other services which are provided on an outreach basis tend to only have outpatient or day case appointments and do not have residential accommodation. However, this is included as we are keen to hear your views.

Factors you might want to consider in identifying a preferred option

You may find it helpful to consider the following factors when responding to the consultation, as well as any other issues not listed which are important to you.

• A service that can bring together patients with similar characteristics for example, underlying condition or age.
• A service that can offer peer support.
• A service where peer support is more likely to be sustained after the treatment is complete.
• A service that can bring together the range of clinical staff.
• A service that can offer a range of treatments and tailored programmes.
• A service that staff want to work in and can be retained in.
• A service that could provide the opportunity to train and support healthcare professionals working in local chronic pain services.
• A service that could support research work.
• A service that makes best use of technology to improve access.